Background. Gestational diabetes mellitus (GDM) poses a substantial risk of adverse maternal, fetal and child health outcomes, and may be influenced by HIV infection. In South Africa (SA), risk-based GDM screening is used owing to resource constraints, but this approach may miss some cases. There is a need to optimise screening methods to efficiently identify pregnant women with GDM. Objectives. To compare risk factor-based screening, the current standard of care and screening with fasting plasma glucose (FPG) to the gold standard of universal GDM screening with an oral glucose tolerance test (OGTT). Methods. We universally screened 399 women with and without HIV attending antenatal care in Gugulethu Community Health Centre, Cape Town, SA, for GDM at 24 - 28 weeks’ gestation using a 2-hour 75 g OGTT. GDM was diagnosed based on the International Association for Diabetes in Pregnancy Study Group criteria. We used logistic regression and receiver operating characteristic curves to compare the screening performance of (i) risk factor-based screening, based on the SA National Department of Health Guidelines for maternity care; and (ii) FPG with and without clinical risk factors including age, body mass index, HIV status and family history of diabetes, with an OGTT (the gold standard). Results. The median (interquartile range) age of participants was 30 (25 - 34) years, and 81% were multiparous. Using OGTT, the prevalence of GDM was 6.3% (9.0% in women with HIV and 3.5% in women without HIV). Risk factor-based screening was poor and showed no discrimination (area under the curve (AUC) 0.53, sensitivity 0.52, specificity 0.55, positive predictive value (PPV) 0.07 and negative predictive value (NPV) 0.94). FPG (AUC 0.91, sensitivity 0.50, specificity 0.98, PPV 0.25 and NPV 0.99) and FPG plus clinical risk factors (AUC 0.98, sensitivity 0.83, specificity 0.97, PPV 0.31, NPV 1.00) showed strong discrimination. FPG had low sensitivity, but this improved greatly when combined with clinical risk factors. Conclusion. Risk factor-based screening, which is the current standard of care, did not discriminate between those with and without GDM. Screening for GDM with FPG and clinical risk factors improved discrimination, and had high sensitivity and specificity, but low PPV. These findings suggest that combining FPG with risk factors may be a practical approach to identify women who should undergo a full OGTT for GDM screening in resource-constrained settings.
South Africa (SA)’s 2-year medical internship programme was introduced with an understandable educational rationale: to provide broader supervised clinical exposure before community service and independent practice. However, the model should now be re-examined within the wider continuum from final-year medical school to internship, compulsory community service and later generalist or specialist work. Readiness for community service is important, particularly in district hospitals with limited support, but 1 compulsory year of community service should not determine the structure of internship for every graduate. Many international comparator systems use a 1-year internship, postgraduate year 1 or specialty-linked model, while SA combines a 2-year internship with additional compulsory service time after graduation. This article questions whether the additional training value of a second internship year is sufficient to justify another compulsory year for every graduate. Recent stakeholder data caution against simply cutting the current programme in half, but do not exclude a redesigned model. A national review should assess whether the current second year remains the best use of training time, supervision and workforce resources.
Background. In South Africa (SA), few recognised centres deal specifically with cases of child abuse, resulting in limited knowledge of the profile of suspected abuse and neglect patients in SA hospitals. The Suspected Child Abuse and Neglect (SCAN) Programme assists with the detection and management of suspected child abuse and neglect in children. Objectives. To provide a retrospective description of the profile of suspected abused and neglected patients presenting to the SCAN Programme at Chris Hani Baragwanath Academic Hospital (CHBAH) from 2018 to 2024. Method. A retrospective, contextual, descriptive research design was used. All patients aged ≤14 years with suspected abuse and or neglect referred to the SCAN Programme at CHBAH were included. Results. A total of 589 patients were included, of whom 316 (53.65%) were female, with a mean (standard deviation) age of 4.60 (4.16) years. The majority of patients (234, 39.73%) were referred from the paediatric department. Of the referrals, 338 (57.39%) were for physical abuse, 129 (21.91, 0%) for sexual abuse, 20 (3.40%) for emotional abuse and 184 (31.24%) for deliberate neglect. Three hundred and fifty-six (60.44%) patients were reported to statutory social services. A majority (76, 32.62%) of patients not reported were already known to these services. For 170 (28.86%) patients, a case docket was opened with the South African Police Service (SAPS), and of these, 35 (5.94%) were enrolled in court. Only 198 (48.65%) patients who had a SCAN Programme Clinic appointment attended the clinic. For the 182 (30.90%) patients for whom no clinic appointment was made, 40 (21.98%) patients were discharged from the SCAN Programme as no abuse or neglect was identified, 33 (18.13%) were transferred back to their referral facility, 56 (30.77%) were removed and placed by statutory social services without notifying the Programme and 37 (20.33%) patients died. Sixteen (8.79%) patients were discharged from the treating ward without notifying the Programme and had unknown outcomes. Conclusion. The SCAN Programme aims to detect suspected abuse and neglect of children early, to protect these patients from harm and to prevent maltreatment. The results of this study highlight the need to expand the SCAN Programme at CHABH to ensure that vulnerable patients receive the needed care.
